Acil servise başvuran yetişkin hastalarda lomber ponksiyon yerinin yatak başı ultrasonografi ve palpasyon ile karşılaştırılması

Abstract

Amaç: Lomber ponksiyon (LP) biyokimyasal, mikrobiyolojik ve sitolojik inceleme için beyin omurilik sıvısı örneğinin alındığı tıbbi bir işlemdir. Çalışmamızda, LP'nin yerini belirlemede ultrasonografi (USG) yöntemiyle palpasyon yöntemini karşılaştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya 203 hasta dahil edildi. Çalışmada, Ultrasonografi (USG) sertifikası olan 4. yılını tamamlayan aynı acil tıp asistanı tarafından manuel veya USG ile yer belirtilmesi yapıldı. Katılan hastalarda lomber ponksiyon yeri önce USG, sonra manuel yöntem ile belirlendi ve işaretlendi. Bulgular: USG yönteminin LP yerleşimini belirlemede manuel yöntemden anlamlı derecede daha başarılı olduğu bulundu (p=0.012). LP bölgesinin belirlenmesinde, USG yöntemi özellikle oturma pozisyonunda, manuel yönteme göre anlamlı olarak daha başarılı olduğu bulunmuştur (p=0.031). Diğer pozisyonlarda iki grup arasında fark gözlenmedi (Sağ p=1, Sol p=0.500). Vücut Kitle İndeksi (VKİ) USG ile alanın yer tayini sırasındaki başarıyı etkiledi (p=0.0001). Benzer şekilde, vücut kitle indeksi, LP bölgesini manuel yöntemle tanımlamadaki başarıyı etkilemiştir (p=0.0001). BMI>25 olan hastalarda LP alanının belirlenmesinde USG yönteminin manuel yöntemden anlamlı derecede daha başarılı olduğu bulundu (p=0.012). Sonuç: Palpasyon veya USG ile LP yer tayininde, vücut kitle indeksi arttıkça, yer bulma süresi önemli ölçüde artmıştır. LP yeri palpasyon ile belirlenemeyen hastalarda USG tarafından tanımlanabilir. Ek olarak, USG, obez bireylerde LP sahasının bulunması açısından daha başarılıdır.

Keywords

• Lomber ponksiyon
• ultrasonografi
• manuel yöntem
• lateral dekübit
• oturur pozisyon

Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room

Abstract

Purpose: Lumbar puncture(LP) is a medical procedure in which a cerebrospinal fluid sample is taken for biochemical, microbiological and cytological examination. The aim of our study was to compare the ultrasonography (USG) method to the palpation method in determining the location of LP. Methods: 203 patients were included in the study. In the study, specifying location manually or with USG was performed by the same emergency medical assistant with USG certificate who completed his 4th year. The lumbar puncture site in the participating patients was determined and marked first by ultrasound and then by manual lumbar puncture. Results: The USG method was found to be significantly more successful than the manual method in determining the LP location(p=0.012) . The USG method was found to be significantly more successful in determining the LP site than the manual method, especially when the LP site was identified in the sitting position(p=0.031). In other positions, no difference was observed between the two groups (Right p=1, Left p=0.500). Body Mass Index(BMI) affects success during site location with USG (p=0.0001). Likewise, body mass index affected the success in identifying the LP site by the manual method(p=0.0001). The USG method was found to be significantly more successful than the manual method in determining the LP site in patients with BMI>25(p=0.012). Conclusion: During the LP location by palpation or USG, as the body mass index increased, the duration of location increased significantly, too. LP site can be identified by the USG in patients whose LP site cannot be specified by palpation. In addition, the USG is more successful in obese individuals in terms of locating the LP site.

Keywords

• Lumbar puncture
• ultrasonography
• manuel method
• lateral decubitus
• sitting position

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